HCV Treatment Reduces Risk of Diabetes

SEATTLE – In a large observational study, treatment of patients diagnosed with hepatitis C virus infection with direct-acting antiviral regimens was associated with a reduced incidence of diabetes occurring within a year after treatment, researchers reported here.

Overall, 1,679 individuals who were not treated for hepatitis C virus were diagnosed with incident diabetes – a rate of 20.6 per 1,000 patient-years compared with 888 cases of diabetes among the individuals treated for hepatitis C virus – and an incident rate of 15.4 per 1,000 patient-years, a significant difference (P<0.001), said Adeel Butt, MD, of the University of Pittsburgh School of Medicine.

In a press conference at the annual Conference on Retroviruses and Opportunistic Infections, Butt said that almost all the difference in diabetes onset was driven by treatment with the direct-acting antivirals.

Among the patients treated with interferon/ribavirin, there were 633 cases of diabetes, for an incident rate of 19.8 per 1,000 patient-years, which was not statistically different from the overall rate for untreated patients (P=0.39)

But there were just 255 cases of diabetes in the patients on direct-acting antivirals, or an incidence of 9.89 per 1,000 patient-years, a highly statistically significant difference (P<0.001), Butt reported.

“Treatment of hepatitis C virus infection with direct-acting antiviral regimens confers benefits beyond virologic control and may be useful in controlling or mitigating some of the extrahepatic complications of hepatitis C virus,” Butt suggested. “We found that hepatitis C virus infection treatment reduces the incidence and risk of subsequent diabetes. This appears to be driven by direct-acting antiviral regimens. We found that the benefit of treatment is more pronounced in persons with more advanced liver fibrosis or cirrhosis.”

He also noted that patients who achieved a sustained virologic response – a functional cure of the disease – also had a lower risk of diabetes. The incident rate was 13.3 per 1,000 patient-years if a sustained virologic response was achieved, compared with a rate of 19.2 per 1000 patient-years if the individuals failed to achieve a sustained response, Butt said.

Press conference moderator Robert Schooley, MD, of the University of California, San Diego, told MedPage Today that it is not clear why treatment of hepatitis C virus infection would have an impact on diabetes: “Diabetes is a complex disease that includes abnormalities in the pancreas, but also in the end organ tissues where insulin acts. Hepatitis is pretty much like a grenade in your liver, which is the center of your metabolism, and whatever is going on in disrupting the metabolism gets into the factors that enhance the incidence of diabetes.”

“Now that we have a way to reverse the process in the liver that drives it is one more reason to treat people with hepatitis C,” Schooley continued. He said it may become more important as the population gets heavier in weight and more diabetes occurs in that group.

For the study, Butt and colleagues scrutinized the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES) and included 4,764 patients who were treated for hepatitis C virus infection with the combination of PEG-interferon and ribavirin, who were matched with 4,764 untreated controls.

The researchers also included a second cohort of 21,279 patients with hepatitis C virus infection who were treated with direct-acting antivirals and matched with 21,279 untreated controls.

The patients were treated with at least 8 weeks of any direct-acting antiviral regimen that had been approved by the Food and Drug Administration or by at least 24 weeks of the interferon/ribavirin combination.

The treated population had a median age of 61, compared with 58 for the untreated population. About 54% of the patients were white; about 29% were black; about 3% were Hispanic; and 96% of the cohort were men, representing the sexual makeup of veterans treated at Veterans Affairs health centers. Patients’ body mass index averaged about 27 in all arms of the study.